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Rapid diagnostic tests (RDTs) facilitate fast and accurate identification of infectious disease microorganisms and are a valuable component of multimodal antimicrobial stewardship (AMS) programs but are currently underutilized in the Asia-Pacific region. An experienced group of infectious diseases clinicians, clinical microbiologists, and a clinical pharmacist used a modified Delphi consensus approach to construct 10 statements, aiming to optimize the utility and applicability of infection-related RDTs for AMS in the Asia-Pacific region. They provide guidance on definition, types, optimal deployment, measuring effectiveness, and overcoming key challenges. The Grading of Recommendations Assessment, Development, and Evaluation system was applied to indicate the strength of the recommendation and the quality of the underlying evidence. Given the diversity of the Asia-Pacific region, the trajectory of RDT development will vary widely; the collection of local data should be prioritized to allow realization and optimization of the full benefits of RDTs in AMS.

A prospective study conducted in a Thai general practice clinic demonstrated a high prevalence (91.3%) of inappropriate empirical antibiotic use in women with uncomplicated cystitis and 42.6% Escherichia coli fluoroquinolone resistance. An annual update of antimicrobial resistance surveillance data of uropathogens may permit targeted treatment of patients in hospital care.

Background We evaluated the extent to which hospital characteristics, infection control practices, and compliance with prevention bundles impacted multidrug-resistant organism (MDRO) infections in Thai hospitals. Methods From 1 January 2014 to 30 November 2014, we surveyed all Thai hospitals with an intensive care unit and ≥250 beds. Infection control practices for methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Acinetobacter baumannii (MDR-AB) were assessed. Linear regression was used to examine associations between hospital characteristics and prevention bundle compliance and changes in MDRO infection rates. Results A total of 212 of 245 (86.5%) eligible hospitals responded. Most hospitals regularly used several fundamental infection control practices for MRSA and MDR-AB (ie, contact precautions, private room/cohorting, hand hygiene, environmental cleaning, and antibiotic stewardship); advanced infection control practices (ie, active surveillance, chlorhexidine bathing, decolonization for MRSA, and hydrogen peroxide vaporizer for MDR-AB) were used less commonly. Facilities with ≥75% compliance with the MRSA prevention bundle experienced a 17.4% reduction in MRSA rates (P = .03). Although the presence of environmental cleaning services (41.3% reduction, P = .01) and a microbiology laboratory (82.8% reduction, P = .02) were among characteristics associated with decreases in MDR-AB rates, greater compliance with the MDR-AB prevention bundle did not lead to reductions in MDR-AB rates. Conclusions Although fundamental MRSA and MDR-AB control practices are used regularly in most Thai hospitals, compliance with more comprehensive bundled prevention approaches is suboptimal. Improving compliance with bundled infection prevention approaches and promoting the integration of certain hospital factors into infection control efforts may help reduce MDRO infections in Thai hospitals.

Anti-interferon (IFN)-γ autoantibodies are increasingly recognized as a cause of adult-onset immunodeficiency and increased risk for infections with intracellular pathogens. We report on disseminated Talaromyces (Penicillium) marneffei and Mycobacterium abscessus infection in a 72-year-old, human immunodeficiency virus noninfected, Thai man with anti-IFN-γ autoantibody. The patient was successfully treated with antimicrobial therapy and rituximab to control B cell-derived autoantibodies.

Background There is limited data on incidence of MDROs colonization and outcome in patients undergoing elective orthopedic surgery. Methods We performed MDROs surveillance screening (swabs from nose, throat, groins, and rectum) in patients undergoing elective orthopedic surgery at the Thammasat University Hospital between March and August 2016. MDROs were defined as Gram-negative bacteria (GNB) possessing extended-spectrum β-lactamases (ESBLs), Carbapenem-resistant Enterobacteriaceae (CRE), and non-lactose fermenting GNB resistant to at least 3 antibiotic classes, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin resistant enterococci (VRE). MDROs were identified by the Vitek®2 automated system. Antimicrobial susceptibility testing (disk diffusion test) was performed using the CLSI Interpretive Guidelines. Incidence of MDROs colonization upon admission was determined. Patient’s clinical characteristics, risk factors for MDROs infection, procedure types and antibiotic prophylaxis were prospectively collected. Surgical sites infections (SSIs) and complications up to 6 months after surgery among the patients with and without MDROs colonization were compared. Results Of 384 swabs tested from 96 patients (median age, 58 years), ESBL-producing Escherichia coli (ESBL-E. coli) was identified in 31 rectal swabs (32.3%) and 7 groin swabs (7.3%). Seven patients (7.3%) were diagnosed with SSIs. A higher rate of SSIs was found among patients with ESBL-E. coli colonization (6/31, 19.4%) compared with patient without ESBL-E. coli colonization (1/65, 1.5%; P = 0.004, OR 15.4, 95% CI 1.7–356.3). From the multivariate logistic regression analysis, SSIs were significantly associated with ESBL-E.coli colonization (P = 0.009, adjusted OR 18.3, 95% CI 2.1–162.9). In addition, from the multivariate logistic regression analysis, ESBL-E.coli was a significantly risk factor associated with SSIs (6/7, 85.7%, P = 0.014, adjusted OR 16.5, 95% CI 1.8–153.4). Conclusion We found a high incidence of ESBL-E. coli colonization and rate of SSIs in patients who had elective orthopedic surgery. These patients did not have any other risk factors for MDROs infection. Active screening for colonization of ESBL-producing pathogens may be necessary to guide appropriate antibiotic prophylaxis to reduce rates of SSIs. Disclosures All authors: No reported disclosures.

Fourteen (3%) of 495 Thai health care personnel were identified as having a serum sickness-like reaction in 2008 after receipt of inactivated influenza vaccine manufactured in Thailand. These health care personnel experienced fever, myalgia, centrifugal arthralgias, and injection site erythema. A history of allergic reactions to food or drugs (adjusted odds ratio, 5.9; 95% confidence interval, 1.54-25.4) was independently associated with a serum sickness-like reaction.

Ventilator-associated pneumonia (VAP) is considered to be an important cause of infection-related death and morbidity in intensive care units (ICUs). We sought to determine the long-term effect of an educational program to prevent VAP in a medical ICU (MICU). A 4-year controlled prospective quasi-experimental study was conducted in an MICU surgical ICU (SICU) and coronary care unit (CCU) for 1 year before the intervention (period 1) 1 year after the intervention (period 2) and 2 follow-up years (period 3). The SICU and CCU served as control ICUs. The educational program involved respiratory therapists and nurses and included a self-study module with preintervention and postintervention assessments lectures fact sheets and posters. Before the intervention there were 45 episodes of VAP (20.6 cases per 1000 ventilator-days) in the MICU 11 (5.4 cases per 1000 ventilator-days) in the SICU and 9 (4.4 cases per 1000 ventilator-days) in the CCU. After the intervention the rate of VAP in the MICU decreased by 59% (to 8.5 cases per 1000 ventilator-days; p = .001) and remained stable in the SICU (5.6 cases per 1000 ventilator-days; P = .22) and CCU (4.8 cases per 1000 ventilator-days; P = .48). The rate of VAP in the MICU continued to decrease in period 3 (to 4.2 cases per 1000 ventilator-days; P = .07) and rates in the SICU and CCU remained unchanged. Compared with period 1 the mean duration of hospital stay in the MICU was reduced by 8.5 days in period 2 (P < .001) and by 8.9 days in period 3 (P < .001). The monthly hospital antibiotic costs of VAP treatment and the hospitalization cost for each patient in the MICU in periods 2 and 3 were also reduced by 45%-50% (P < .001) and 37%-45% (P < .001) respectively. A focused education intervention resulted in sustained reductions in the incidence of VAP duration of hospital stay cost of antibiotic therapy and cost of hospitalization. (authors)

We report 3 cases of Burkholderia pseudomallei liver abscesses that have a characteristic "honeycomb" appearance on computed tomography scans. Such a finding should prompt physicians to include B. pseudomallei infection in the differential diagnoses of liver abscesses and consider initiation of empirical therapy for melioidosis in high-risk patients from areas of endemicity.

Background. We conducted a study to evaluate the impact of education and an antibiotic-control program on antibiotic-prescribing practices antibiotic consumption antimicrobial resistance and cost of antibiotics in a tertiary care hospital in Thailand. Methods. A study of the year before and the year after the intervention was performed. Inpatient antibiotic prescriptions were prospectively observed. Demographic characteristics hospital unit indication for antibiotic prescription appropriateness of antibiotic use reasons for inappropriate antibiotic use antibiotic consumption (i.e. the rate of antibiotic use) bacterial resistance and antibiotic cost data were collected. Interventions included education introduction of an antibiogram use of antibiotic prescription forms and prescribing controls. Results. After the intervention there was a 24% reduction in the rate of antibiotic prescription (640 vs. 400 prescriptions/1000 admissions; P < .001). The incidence of inappropriate antibiotic use was significantly reduced (42% vs. 20%; P < .001). A sustained reduction in antibiotic use was observed (R(2) = 0.692; P

Successful treatment of severe Clostridium difficile colitis has been reported with the use of adjunctive intracolonic vancomycin (ICV) therapy. We report a descriptive case series and review the literature on patients with C. difficile colitis who received adjunctive ICV therapy. Nine patients received antibiotics within 6 weeks prior to presentation. Complete resolution of the clinical presentation occurred in 8 patients (88.9%), and eradication of C. difficile cytotoxin production was documented in 3 (75%) of 4 patients who were tested after the completion of adjunctive ICV therapy. One patient (11.1%) died as a result of progressive multisystem organ failure. In the 6 weeks after the completion of treatment for C. difficile colitis, no patient had recurrent disease, required surgical intervention, or experienced complications from adjunctive ICV therapy. In this case series, administration of adjunctive ICV therapy appeared to be a safe, practical, and effective adjunctive therapy for severe C. difficile colitis.

Diagnosis: Capillariasis associated with tubular narrowing of multiple small-bowel loops with fold effacement. The clinical and radiographic presentations of these cases are representative of Capillaria philippinensis infection. Infection with C. philippinensis is primarily acquired by ingestion of raw, undercooked, small, fresh- or brackish-water fish [1]. Capillaria philippinensis, first discovered in the Philippines, has subsequently been detected in Thailand, Japan, Iran, Egypt, and Taiwan, with major outbreaks reported in Thailand and the Philippines [2]. Typically, patients present with signs and symptoms of malabsorption inclusive of chronic diarrhea, edema, muscle wasting, and abdominal pain; laboratory data reveal low serum albumin and potassium [3–4]. The diagnosis of C. philippinensis is usually based on the detection of eggs (Figure 1), larva, and/or adult worms with or without egg in stool specimens (Figure 1), although excretion can be sporadic, necessitating multiple repeated stool examinations, with small intestinal aspiration or biopsy to confirm the diagnosis in some cases [1–2]. Notably, mortality has been reported in patients with C. philippinensis who did not have capillaria eggs or larva recovered from stool specimens [2–3]. The detection of the parasite’s stichosome (the posterior glandular esophagus) and stichocytes (large glandular cells) by hematoxylin and eosin stain are not diagnostic, as these can also be identified in biopsies of patients with Trichinella spiralis and Trichuris trichiura infection. The clinical presentations and locations of lesions can readily help in the differentiation and case detection of these 3 parasitic infections [5]. Whereas patients with C. philippinensis typically present with clinical manifestations of chronic watery diarrhea and malabsorption, those with T. trichiura usually present with prolonged diarrhea, blood-streaked stool, anemia, colitis, proctitis, and rectal prolapse (in patients with heavy infestation). Cases with T. spiralis usually have biphasic presentations that begin with clinical manifestations of nausea, vomiting, and diarrhea (intestinal phase) followed by intense myalgias and periorbital edema (muscular phase) [5]. Additionally, C. philippinensis typically involves the distal jejunum and proximal ileum, T. trichiura tends to cause lesions limited to the large bowel, and T. spiralis is typically associated with encysted larva that migrated to specific organ tissues (eg, muscle, myocardium, and brain). In each of our 4 reported cases, the initial stool specimen was negative for C. philippinensis. Subsequent stool specimens were positive for C. philippinensis in 2 patients, and all 4 had small-bowel biopsies remarkable for severe villous blunting, inflammatory cell infiltration, and visualization of nematodes in longitudinal sections with the identification of stichocytes